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Background: It is often difficult to perform percutaneous radiofrequency ablation (RFA) for hepatic tumors beneath the diaphragm. Diaphragmatic thermal damage is one of the fatal late complications of percutaneous transdiaphragmatic RFA. Our experience with laparoscopic transthoracic transdiaphragmatic intraoperative RFA (LTTI-RFA) for hepatic tumors beneath the diaphragm is reported. Methods: Ten patients who underwent LTTI-RFA from 2009 to 2012 were evaluated. Two cases had concomitant partial hepatectomy, and one underwent RFA for two tumors at the same time. The diagnosis was hepatocellular carcinoma in eight cases and metastatic hepatic tumors in two cases. Nine of eleven tumors were located at segments 7 and 8. Nine tumors were less than 20 mm in diameter. The patients were placed in the half left lateral decubitus position with single-lumen tube intubation. After placement of four abdominal ports, a 12-mm port was inserted in the fourth or fifth intercostal space into the diaphragm. The tumor was ablated by an RFA needle through the port. The routine follow-up consisted of laboratory tests and abdominal imaging every 3-6 months. Results: The median operation time for only one tumor was 137 minutes (range, 105-187 minutes). The median number of times for ablation was three. Severe postoperative complications (>Clavien-Dindo IIIa) were observed in one case (right upper limb paralysis). The median follow-up period was 35 months (range, 11-43 months). There was no local tumor progression. Recurrent hepatic tumor appearance occurred in other parts of the liver in 6 of the 11 patients. Conclusions: Laparoscopic transthoracic transdiaphragmatic RFA is an acceptable procedure with a low rate of local recurrence.

Background: It is often difficult to perform percutaneous radiofrequency ablation (RFA) for hepatic tumors beneath the diaphragm. Diaphragmatic thermal damage is one of the fatal late complications of percutaneous transdiaphragmatic RFA. Our experience with laparoscopic transthoracic transdiaphragmatic intraoperative RFA (LTTI-RFA) for hepatic tumors beneath the diaphragm is reported. Methods: Ten patients who underwent LTTI-RFA from 2009 to 2012 were evaluated. Two cases had concomitant partial hepatectomy, and one underwent RFA for two tumors at the same time. The diagnosis was hepatocellular carcinoma in eight cases and metastatic hepatic tumors in two cases. Nine of eleven tumors were located at segments 7 and 8. Nine tumors were less than 20 mm in diameter. The patients were placed in the half left lateral decubitus position with single-lumen tube intubation. After placement of four abdominal ports, a 12-mm port was inserted in the fourth or fifth intercostal space into the diaphragm. The tumor was ablated by an RFA needle through the port. The routine follow-up consisted of laboratory tests and abdominal imaging every 3-6 months. Results: The median operation time for only one tumor was 137 minutes (range, 105-187 minutes). The median number of times for ablation was three. Severe postoperative complications (>Clavien-Dindo IIIa) were observed in one case (right upper limb paralysis). The median follow-up period was 35 months (range, 11-43 months). There was no local tumor progression. Recurrent hepatic tumor appearance occurred in other parts of the liver in 6 of the 11 patients. Conclusions: Laparoscopic transthoracic transdiaphragmatic RFA is an acceptable procedure with a low rate of local recurrence.

Background: It is often difficult to perform percutaneous radiofrequency ablation (RFA) for hepatic tumors beneath the diaphragm. Diaphragmatic thermal damage is one of the fatal late complications of percutaneous transdiaphragmatic RFA. Our experience with laparoscopic transthoracic transdiaphragmatic intraoperative RFA (LTTI-RFA) for hepatic tumors beneath the diaphragm is reported. Methods: Ten patients who underwent LTTI-RFA from 2009 to 2012 were evaluated. Two cases had concomitant partial hepatectomy, and one underwent RFA for two tumors at the same time. The diagnosis was hepatocellular carcinoma in eight cases and metastatic hepatic tumors in two cases. Nine of eleven tumors were located at segments 7 and 8. Nine tumors were less than 20 mm in diameter. The patients were placed in the half left lateral decubitus position with single-lumen tube intubation. After placement of four abdominal ports, a 12-mm port was inserted in the fourth or fifth intercostal space into the diaphragm. The tumor was ablated by an RFA needle through the port. The routine follow-up consisted of laboratory tests and abdominal imaging every 3-6 months. Results: The median operation time for only one tumor was 137 minutes (range, 105-187 minutes). The median number of times for ablation was three. Severe postoperative complications (>Clavien-Dindo IIIa) were observed in one case (right upper limb paralysis). The median follow-up period was 35 months (range, 11-43 months). There was no local tumor progression. Recurrent hepatic tumor appearance occurred in other parts of the liver in 6 of the 11 patients. Conclusions: Laparoscopic transthoracic transdiaphragmatic RFA is an acceptable procedure with a low rate of local recurrence.

Background: It is often difficult to perform percutaneous radiofrequency ablation (RFA) for hepatic tumors beneath the diaphragm. Diaphragmatic thermal damage is one of the fatal late complications of percutaneous transdiaphragmatic RFA. Our experience with laparoscopic transthoracic transdiaphragmatic intraoperative RFA (LTTI-RFA) for hepatic tumors beneath the diaphragm is reported. Methods: Ten patients who underwent LTTI-RFA from 2009 to 2012 were evaluated. Two cases had concomitant partial hepatectomy, and one underwent RFA for two tumors at the same time. The diagnosis was hepatocellular carcinoma in eight cases and metastatic hepatic tumors in two cases. Nine of eleven tumors were located at segments 7 and 8. Nine tumors were less than 20 mm in diameter. The patients were placed in the half left lateral decubitus position with single-lumen tube intubation. After placement of four abdominal ports, a 12-mm port was inserted in the fourth or fifth intercostal space into the diaphragm. The tumor was ablated by an RFA needle through the port. The routine follow-up consisted of laboratory tests and abdominal imaging every 3-6 months. Results: The median operation time for only one tumor was 137 minutes (range, 105-187 minutes). The median number of times for ablation was three. Severe postoperative complications (>Clavien-Dindo IIIa) were observed in one case (right upper limb paralysis). The median follow-up period was 35 months (range, 11-43 months). There was no local tumor progression. Recurrent hepatic tumor appearance occurred in other parts of the liver in 6 of the 11 patients. Conclusions: Laparoscopic transthoracic transdiaphragmatic RFA is an acceptable procedure with a low rate of local recurrence.

type:text, In order to assess the usefulness of CT functional images, twenty one cases with liver masses were studied. We tried to minimize the motion artifacts by immobilizing the patients with a girdle in performing dynamic CT scans, and by discarding some of the segmented images with serious artifacts before constructing functional images. The qualities of images obtained were considered satisfactory. Of the several transit parameters obtained from the dynamic CT scans, we found the first moment (Ml) to be most useful and the effectiveness of Ml-functional images were studied. In all cases with hepatocellular carcinomas (12 cases) and intrahepatic cholangiocarcinomas (2 cases), the Ml-functional images showed the viable portions of tumors as accumulations of dark pixels reflecting rapid transit times due to arterial blood supply. In three cases with hepatic cavernous hemangiomas, the lesions were represented as bright areas with a well-defined border. In two cases with hepatic abscesses, the Ml-functional images suggested the presence of hyperemia in the surrounding tissue as demonstrated by bright pixels around the lesions. CT functional imaging was proved to be useful for evaluating the circulatory dynamics of contrast material and the differential diagnosis of liver tumors when conventional or dynamic CT studies failed to provide enough information. This technique enabled overall analysis of time-density curves for the entire plane of an image semiautomatically and without the subjective maneuver of setting ROI's (regions of interest).

In order to assess the usefulness of CT functional images, twenty one cases with liver masses were studied. We tried to minimize the motion artifacts by immobilizing the patients with a girdle in performing dynamic CT scans, and by discarding some of the segmented images with serious artifacts before constructing functional images. The qualities of images obtained were considered satisfactory. Of the several transit parameters obtained from the dynamic CT scans, we found the first moment (Ml) to be most useful and the effectiveness of Ml-functional images were studied. In all cases with hepatocellular carcinomas (12 cases) and intrahepatic cholangiocarcinomas (2 cases), the Ml-functional images showed the viable portions of tumors as accumulations of dark pixels reflecting rapid transit times due to arterial blood supply. In three cases with hepatic cavernous hemangiomas, the lesions were represented as bright areas with a well-defined border. In two cases with hepatic abscesses, the Ml-functional images suggested the presence of hyperemia in the surrounding tissue as demonstrated by bright pixels around the lesions. CT functional imaging was proved to be useful for evaluating the circulatory dynamics of contrast material and the differential diagnosis of liver tumors when conventional or dynamic CT studies failed to provide enough information. This technique enabled overall analysis of time-density curves for the entire plane of an image semiautomatically and without the subjective maneuver of setting ROI's (regions of interest).

In order to assess the usefulness of CT functional images, twenty one cases with liver masses were studied. We tried to minimize the motion artifacts by immobilizing the patients with a girdle in performing dynamic CT scans, and by discarding some of the segmented images with serious artifacts before constructing functional images. The qualities of images obtained were considered satisfactory. Of the several transit parameters obtained from the dynamic CT scans, we found the first moment (Ml) to be most useful and the effectiveness of Ml-functional images were studied. In all cases with hepatocellular carcinomas (12 cases) and intrahepatic cholangiocarcinomas (2 cases), the Ml-functional images showed the viable portions of tumors as accumulations of dark pixels reflecting rapid transit times due to arterial blood supply. In three cases with hepatic cavernous hemangiomas, the lesions were represented as bright areas with a well-defined border. In two cases with hepatic abscesses, the Ml-functional images suggested the presence of hyperemia in the surrounding tissue as demonstrated by bright pixels around the lesions. CT functional imaging was proved to be useful for evaluating the circulatory dynamics of contrast material and the differential diagnosis of liver tumors when conventional or dynamic CT studies failed to provide enough information. This technique enabled overall analysis of time-density curves for the entire plane of an image semiautomatically and without the subjective maneuver of setting ROI's (regions of interest).